Benefits of botulinum toxin type A in shoulder dysfunction and regional pain in assistance to reconstructive mammary surgery: A pilot study

Introduction/Background Shoulder dysfunction and regional pain in patients undergoing breast reconstruction with prostheses due to breast cancer is a long-term disabling condition. To evaluate the effect of botulinum toxin type A 60 U IM regarding the volume differences of the affected arm before and after treatment. Material and method Descriptive longitudinal study of a rehabilitation program during the reconstructive process addressed to women undergoing mastectomy and lymphadenectomy. All patients performed a structured program of group exercise before infiltration. Subsequently, if pain persisted and functional joint range decreased, a 60 U injection of botulinum toxin type A (Xeomin ® ) was performed in pectoralis major with ultrasound elastography. The difference in volume, distal force measured by claw dynamometry and VAS symptoms (pain, heaviness, tightness and hardness) was evaluated before (T0), at one (T1) and at six months (T2) of treatment, as well as changes in ultrasound images. SPSS 16.0 statistic program was used to compare paired data means (95% CI alfa 0.005). Results Ten patients were selected. Baseline characteristics were: mean average age 51.1 years. Nine right-handed, nine with right arm affected (8 right, 1 bilateral). They all presented significant improvements regarding pain, heaviness, tightness and hardness (T0–T1) that remained at 6 months for tightness and hardness (T0–T2). They did not present significant differences in regard to volume difference or distal claw force after infiltration. Conclusion The use of botulinum toxin at doses of 60 U IM in pectoralis major has been shown to be a safe technique for lymphedema, improving symptoms during the first month post-infiltration without decreasing distal claw force.